Chapter 22: Vestibular system Flashcards

1
Q

vestibular system

A

-functions to keep us visually and physically steady in the world

  • Contributes to maintenance of balance and equilibrium:
  • head movement and position relative to gravity
  • Gaze stabilization- VOR
  • Postural adjustments
  • Autonomic function and consciousness (connections to reticular formation, problems indicate problem in homeostasis)

*Vestibulospinal tracts- keep us upright- Brainstem so we have a low degree of direct voluntary control

Cerebrocortex=conscious cortex

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2
Q

Vestibular apparatus

A

Inner ear-just inside, buried deep

CN VIII- Cochlea (hearing part), Vestibular part (balance part)

Considering vestibular- balance part in this chapter

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3
Q

Semicircular canals

A

5 pieces

-between all there they detect any movement
-3 per side
-anterior- 45 degrees off centered pointing in front
-posterior- 45 degrees off centered behind
Horizontal- lateral a bit tilted

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4
Q

hair cells in fluid

A

seaweed and shamrocks (seaweed is hair follicles)

-At end of canals there is ampula- in ampula there are hair cells- when straight up they are still sending some action potential to tell there is no movement.

When head moves- hair cells send more action potential
-Bent to the opposite side- hair cells send less action potential

Baseline activity** hair cells always sending signals

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5
Q

Semicircular canals detection

A

detects angular movements of head

  • really sensitive to being bent and unbent (acceleration and deceleration)
  • the side you turn to sends more action potential
  • the side you are turning away from sends less action potential
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6
Q

semicircular canals paired activity

A

takes pairing to let brain know which way you are moving

  • R anterior and L posterior detect movement in one plane
  • L anterior and R posterior detect movement in one plane
  • R and L horizontal detect movement in one plane
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7
Q

Review

A

Optokinetic reflex and optokinetic nystagmus are the same thing
-optokinetic reflex works both with slow head moving, object not (this does not excite inner ear because it is a slow movement object moving, head not)

-Nystagmus is a fast reset to find another object (something new) to track (driving down the street)

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8
Q

Review

A

Right optic tract damage produces left homonymous hemianopsia

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9
Q

peripheral vestibular system

A

detects angular movement

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10
Q

Otolithic organs

A

include:

  • Utricle
  • Saccule
  • Linear movements and pull of gravity
  • Utricle- horizontal
  • Saccule- linear/verticle

Otoconia- blobs on top of hair cells

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11
Q

Otolithic organs

A
  • Haircells are in jelly
  • baseline activity
  • Depolarization
  • -gravity, linear, acceleration, deceleration
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12
Q

vestibular nerve

A

From vestibular apparatus to brainstem nuclei

  • Pathway from CN VIII-vestibular system
  • Ends at belt line- pons and medullar junction
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13
Q

Central vestibular system-vision

A

part of equilibrium, helps vestibular nuclei know how we are positioned

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14
Q

Central vestibular system-Proprioception

A

connected to muscle spindles

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15
Q

Central vestibular system-Weight shifts

A

Gets information from superficial sensors like pressure and touch

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16
Q

Central vestibular system- Auditory information

A

Sound can help confirm movement for vestibular nuclei

-vestibular nuclei receives all information- conceives it, decides what needs to be done to stay upright

17
Q

central vestibular system

A

There is a pathway that goes to cerebral cortex so you know equilibrium and confirm it

18
Q

eye movement

A

Vestibular system outputs to eyes to VOR to help visual work keep steady

19
Q

MLF- Medial longitudinal fasciculus

A

vestibular nuclei excite to the MLF to keep vision steady and keeps eyes moving together
-Superior colliculus responds to visual input

20
Q

Head movement

A

Vestibular nuclei- Sends signals to muscles that control head- stay up in pull of gravity

-Vestibular nuclei- directly control head movement

21
Q

Posture of head and body

A

Medial and lateral vestibulospinal facilitated to catch on side of fall and inhibit on opposite side to get back upright

22
Q

Reticular formation

A
  • Sometimes movement of head and body change homeostasis

- If reticular formation determines movement is threat to homeostasis- get nauseous- still threat- throw up

23
Q

Visual-Vestibular interaction

A

Activity in the visual cortex and vestibular are reciprocally inhibitory:

  • Increased visual cortex activity inhibits the vestibular cortex
  • Increased vestibular cortex activity inhibits the visual cortex

*reciprocally inhibitory (a lot of visual stimulation-vestibular becomes inhibited)

24
Q

Signs and Symptoms of vestibular disorders

A

damage to peripheral receptors (semicircular canals and otolithic organs) or to CN, Brainstem nuclei, central projection axons, or cortical reception areas.

Pusher syndrome- pathway from inner ear to cortex gets damaged- Pt feels like they are falling over and when they try to push themselves back to alignment they are actually pushing self over.

25
Q

S&S

A
  • vertigo
  • nausea/vomiting
  • Pathologic nystagmus
  • Disequilibrium (impaired gaze stabilization)
  • Vestibular ataxia (don’t feel upright or mvmt)
  • Oscillopsia (complete lack of gaze stabilization, complete lack of VOR)
26
Q

Need to distinguish

A

distinguish:

  • peripheral (BPPV) vs. central
  • Unilateral vs. Bilateral
  • Hyperfunction vs. Hypofunction
27
Q

normal peripheral vestibular function

A

at rest= size of the two signals tells you the amount of action potential being sent

-Head turn to the right
AP goes up on right side
AP goes down on left side

eyes see, body feels, inner ear system messages confirmed

28
Q

Unilateral hyperfunction (peripheral BPPV)

A

vestibular apparatus malfunctioning and one side is more active than it should be

-Benign paroxysmal positional vertigo (BPPV)- not deadly, no apparent cause, occurs with certain positions/movements of head, spinning)

Posterior- turn head 45 degrees, tilt back

-Nystagmus quick phase is in direction of way head is moving- in direction of pathology

  • acute comes on all at once mismatch- out of all of the possible symptoms two show up the most:
  • PROFOUND DIZZINESS (due to mismatch)
  • NAUSEA- due to acute mismatch, especially vertigo

definition- Crystals floating in semicircular canal
cause inappropriate excitation.
This causes one inner ear to effectively
signal “I’m moving” even when the head
is still.

29
Q

hyperfunction (BPPV) unilateral peripheral

A
  • dizziness
  • Nausea
  • Postural instability- conditions present but usually individual stays put (person doesn’t want to move)
  • Reduced gaze stabilization- VOR temporarily broken, person does not move so not very present
30
Q

Unilateral hypofunction (peripheral, neuritis)

A

-vestibular neuritis- squeezing of CN VIII- one side has too little signal- night night

  • Neuritis- compression of CN VIII where pierces the skull to go into the brainstem- does not come on as big or as acutely (it sneeks up on you, and is a little bit more insidious onset)
  • input from one ear insidiously drops/goes away

Damage to Cranial Nerve VIII on one side leads to reduction of action potentials from one inner ear. This results in a chronic mismatch of signals from the two ears.

  • Right ear isn’t available to tell me that the head is turning to the right (world is blurry because my eyes go with my head and I have to focus on the world as I move, Like running with camera on cops (no gaze stabilization)
  • Less signals from the right inner ear means that in the vestibulospinal tracts, the right side wont be as facilitated as the left and so they will have less postural stability on one side because of the difference in input
  • blurry when I turn head, when I walk, and I feel unstable
31
Q

S&S of neuritis

A

(hypofunction/peripheral/ unilateral)

  • reduced gaze stabilization, especially to one side
  • postural instability (impaired VOR and reduced vestibulospinal activity)
  • Dizziness
  • Nausea
  • doesn’t report vertigo because there is no acute mismatch, doesn’t report nausea because there is no acute mismatch
  • very likely will report feeling dizzy but not spinning, just unstable.
  • body cant accommodate to the loss of OR and loss of vestibulospinal tract (have to become good at consciously controlling the eyes). make the VOR reflex a conscious stabilization of the world=TREATMENT (gaze instability and blurriness)
32
Q

Hypofunction (bilateral peripheral)

A
  • -significantly reduced gaze stabilization:
  • Oscillopsia- no visual stability with head movements (like cops camera)

Kills sensors of the ears on both sides (no VOR at all)
-will have postural instability because the vestibulospinal tracts have been lost or less facilitated on both sides

Some drugs can have a way of destroying neurons in CN VIII (ototoxic)